In a double-blind prospective study of 200 sequential urine specimens the sediment count of leukocytes in the centrifuged urine (white blood cells per high power field) was compared to a chamber count of leukocytes in uncentrifuged urine (white blood cells per microliter.). There was good correlation (coefficient of correlation 0.783, sensitivity 91.9 per cent, specificity 97.6 per cent and efficiency 96.6 per cent) between the more precise chamber count and the more commonly performed sediment count if the methodology of the sediment count was standardized. In a double-blind prospective study the results of the sediment count for leukocytes and erythrocytes were compared to the leukocyte esterase and hemoglobin dipstick results of urine specimens from 1,346 adults who underwent multiphasic screening. The dipsticks were found to be sensitive to physiologic limits for leukocytes and erythrocytes, with only 0.9 per cent false negative results for each. Formed elements in the urine not detectable by dipstick, such as casts and crystals, were present in 3 per cent of the specimens. Among patients who had significant pyuria, hematuria or formed elements not detectable by dipstick chemical urinalysis, no significant pathological condition was detected upon retrospective review. Because the chemical dipstick is not quantitative and because the sensitivity of the dipsticks resulted in many false positive findings compared to the sediment count (red and white blood cells 16.4 and 13.2 per cent, respectively) a protocol is offered in which results of screening urine specimens that are positive on dipstick culture would be confirmed by a properly performed microscopic urinalysis. This protocol as applied to an adult screening population would be an accurate, cost-effective method of urine testing.

The patient had an uneventful recovery and returned to normal activity. Primary intracranial myxoma should be distinguished from other meningeal tumors and metastatic cardiac myxoma by appropriate pathological analysis and cardiac evaluation. A circumscribed myxoma completely excised with adequate dural margin carries a good prognosis for surgical cure.

A cost-effective urinalysis test strategy, employing screening dipstick analysis with sediment microscopy performed on urines positive for leukocyte esterase, nitrite, protein, or blood, is evaluated. Screening urine culture is done when greater than or equal to 5 WBC/HPF, greater than 10 bacteria/HPF, or yeasts are found on sediment microscopy. Predictive value, sensitivity, and specificity of the test strategy in predicting significant bacteriuria is compared with sediment microscopy, Gram staining of uncentrifuged urine and leukocyte chamber counting. Employment of the test protocol for routine urine specimens would decrease sediment microscopy by 49%, while effectively screening for significant bacteriuria with a sensitivity of 88.9% and predictive value of a negative result of 98.8%.

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The performance of a urinalysis protocol using screening Chemstrip-9 dipstick analysis with selective sediment microscopy and culture is reviewed. Sediment microscopy performed on urine samples positive for leukocyte esterase, nitrite, protein, or blood, or when specifically ordered (15% of urinalyses) was reduced by 57.1%. Protocol urine culture performed when more than 5 WBC/high-powered field (HPF), more than 10 bacteria/HPF, or yeasts were found on sediment microscopy or with a positive nitrite test was done for 9.8%. Urine culture was specifically ordered for another 13.6%. Percent significant bacteriuria (greater than or equal to 10(5) colony-forming units/mL) was higher for protocol-generated cultures (37.1%) versus ordered cultures (17.2%). For urinalyses with ordered cultures, the protocol would have detected 89.8% of cases with significant bacteriuria. The protocol has facilitated detection of significant bacteriuria with good acceptance by clinicians. Cost savings achieved by reduction of sediment microscopy was partly off-set by some increase in urine cultures performed.